What clinical features should prompt me to suspect idiopathic intracranial hypertension in a patient?

Clinical features that should prompt suspicion of idiopathic intracranial hypertension (IIH) include:

• New onset headache, often daily and diffuse, which may worsen on lying down or with Valsalva maneuvers such as coughing or straining ¹ (Rehder, 2020).
• Visual disturbances, particularly transient visual obscurations (brief episodes of vision loss or blurring), diplopia, or visual field defects due to papilledema ¹ (Bénard-Séguin É and Costello, 2025).
• Tinnitus, especially pulsatile tinnitus synchronous with the heartbeat, is a common symptom ¹ (Antonio, 2025).
• Signs of raised intracranial pressure such as nausea, vomiting, and neck stiffness may be present but are less specific ¹ (Rehder, 2020).
• On examination, papilledema is a key clinical sign and should raise suspicion of IIH in the appropriate clinical context ¹ (Bénard-Séguin É and Costello, 2025).
• Other neurological deficits are typically absent, and the patient is usually alert and oriented ¹ (Antonio, 2025).

In summary, the combination of new persistent headache, visual symptoms (especially transient visual obscurations), pulsatile tinnitus, and papilledema on examination should prompt consideration of IIH and urgent neuro-ophthalmological assessment ¹ (Rehder, 2020; Bénard-Séguin É and Costello, 2025; Antonio, 2025).